# Atrophic Anterior Mandible Treated With Sandwich Osteotomy Without Mini‐Screws and Mini‐Plates: A Case Report With 7 Years of Follow‐Up

## TL;DR

A 19-year-old patient with a damaged lower jaw was successfully treated using a new bone augmentation technique that avoided mini-screws and mini-plates.

## Contribution

A simplified sandwich osteotomy technique using equine bone without stabilization hardware was successfully demonstrated.

## Key findings

- The augmented bone showed a 5–7 mm vertical increase with no resorption after four months.
- Histological analysis revealed new bone formation around the equine bone block.
- The technique achieved stability without using mini-screws or mini-plates.

## Abstract

Restoring the anterior mandible may be challenging due to both insufficient height and width of the edentulous alveolar ridge; thus, this case report aimed to treat anterior mandibular atrophy by using the inlay technique without the use of mini‐screws or mini‐plates to stabilize the augmented bone fragments. A 19‐year‐old patient who lost his anterior teeth in an accident was treated with a horizontal osteotomy performed 4 mm from the alveolar ridge, with two oblique cuts made using an ultrasonic instrument, and the final phase of the osteotomy was performed with a lever for dental extraction. One mini‐block of equine bone was inserted between the coronal osteotomized segment and the mandibular basal bone, with cancellous equine bone particles filling the residual space. A resorbable collagen membrane was used to cover the biomaterials and mini‐block. Seven days after the augmentation procedure, there were no signs of dehiscence, lesions, infection, or segment movement. Four months after surgery, a CBCT radiograph was obtained for implant placement, revealing a 5–7 mm vertical increase without bone resorption or height loss. The radiographic assessment showed a mineralized zone between basal bone and coronal portion of osteotomized segments, whereas the histological analysis showed new bone and osteoid matrix around and inside the block material. As a result, this case report indicated that using an equine collagenated block in alveolar bone augmentation resulted in high stability while eliminating the need for mini‐screws and mini‐plates, resulting in a simplified sandwich technique.